Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

Abstract

Purpose: To assess the efficacy and safety of preoperative intravitreal bevacizumab (IVB) before vitrectomy for diabetic tractional retinal detachment (TRD).

Methods: Using ICD-9 codes, we located all patients with diabetic TRD who underwent 3-port 20-gauge vitrectomy primarily performed by one surgeon between January 2004 and January 2009. Eyes receiving IVB were compared with those not. The following outcomes were compared: visual acuity (VA), duration of surgery, and complication rates.

Results: A total of 99 eyes of 90 patients were included in the analysis. In all, 34 patients received IVB on an average of 11.5 (range, 3-30) days previtrectomy. Age was 46.5 and 51.6 in the IVB and non-IVB groups, respectively. VA was improved significantly in both groups: from 20/617 to 20/62 in the IVB group, and from 20/443 to 20/86 in the non-IVB group (P=0.11 between groups). Operating time and postoperative complications (glaucoma, RD, and revitrectomy rate) were similar in both groups. On comparing IVB and non-IVB eyes in younger patients (≤ 40), operating time was shorter (P=0.02) and a trend to better VA in the IVB group was seen.

Conclusions: Preoperative IVB may be a useful adjunct to vitrectomy for severe PDR complicated by TRD, particularly in younger diabetics.

Figure 1

Scatterplot of the baseline and postoperative best-corrected VA for patients >40 years of age. Eyes with worsened postoperative VA are plotted above the line.

Figure 2

Scatterplot of the baseline and postoperative best-corrected VA for patients ≤40 years of age.

Figure 3

(a) Preoperative color photographs of PDR complicated by macular TRD in a 26-year-old type 1 diabetic man. Note the high vascularity of the premacular membranes. (b) At 6 months after PPV with preoperative bevacizumab, VA had improved from 20/100 to 20/40.